Predictive factors of Barrett esophagus - Multivariate analysis of 502 patients with gastroesophageal reflux disease
Predictive factors of Barrett esophagus - Multivariate analysis of 502 patients with gastroesophageal reflux disease
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DOI：
10.1001/archsurg.136.11.1267
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发表时间：
2001-11-01
影响因子：
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通讯作者：
DeMeester, TR
中科院分区：
文献类型：
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作者：
Campos, GMR;DeMeester, SR;DeMeester, TR
假设：Barrett食管（BE）的存在和程度的危险因素，可以确定在患者胃食管反流病（GERD）设计：病例比较研究。设置：大学三级转诊center.Patients：502例连续GERD患者记录24小时食管pH值监测和完整的人口。内窥镜检查和生理评估根据BE的存在和程度分组（328例无BE患者和174例BE患者[67例短节段BE和107例长节段BE]）。主要结果测量：临床、内镜和生理数据，通过多变量分析研究，以确定BE存在和程度的独立预测因子。胆汁反流异常（比值比[OR]，4.2; 95%可信区间[CI]，1.9-9.7），食管裂孔疝大于4 cm（OR，4.1; 95%CI，2.1-8.0）。下食管括约肌缺陷（或，2.7; 95% CI，1.4-5.4）。男性（OR，2.6; 95%CI，1.6-4.3）。食管远端收缩缺陷（OR，2.2; 95% CI，1.4-3.5），持续时间超过5分钟的反流发作次数异常（OR，2.2; 95% CI。1.1-4.6），GERD症状持续超过5年（OR，2.1 95% CL 1.4-3.2）。只有异常胆汁反流（OR。4.8; 95% CI，1.7-13.2）被确定为短节段BE的预测因子（基线，无BE）。三个因素被确定为长段BE（基线短段BE）的预测因子。食管裂孔疝大于4 cm（OR，17.8; 95% CI，4.1-76.6），食管下括约肌缺损（OR，16.9 - 95% CI，1.6-181.4），和异常最长反流发作（OR，8.1 - 95% CI，2.8-24.0）。
Hypothesis: Risk factors for the presence and extent of Barrett esophagus (BE) can be identified in patients with gastroesophageal reflux disease (GERD).Design: Case-comparison study.Setting: University tertiary referral center.Patients: Five hundred two consecutive patients with GERD documented by 24-hour esophageal pH monitoring and with complete demographic. endoscopic, and physiological evaluation. divided in groups according to the presence and extent of BE (328 patients without BE and 174 with BE [67 short-segment BE and 107 long-segment BE]).Main Outcome Measures: Clinical, endoscopic, and physiological data, studied by multivariate analysis, to identify the independent predictors of the presence and extent of BE.Results: Seven factors were identified as predictors of BE. They were abnormal bile reflux (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.9-9.7), hiatal hernia larger than 4 cm (OR, 4.1; 95% Cl, 2.1-8.0). a defective lower esophageal sphincter (OR. 2.7; 95% CI, 1.4-5.4). male sex (OR, 2.6; 95% Cl, 1.6-4.3). defective distal esophageal contraction (OR, 2.2; 95% CI, 1.4-3.5), abnormal number of reflux episodes lasting longer than 5 minutes (OR, 2.2; 95% CI. 1.1-4.6), and GERD symptoms lasting for more than 5 years (OR, 2.1 95% CL 1.4-3.2). Only abnormal bile reflux (OR. 4.8; 95% CI, 1.7-13.2) was identified as a predictor of short-segment BE (baseline, no BE). Three factors were identified as predictors of long-segment BE (baseline short-segment BE). They were hiatal hernia larger than 4 cin (OR, 17.8; 95% CI, 4.1-76.6), a defective lower esophageal sphincter (OR, 16.9 95% CI, 1.6-181.4), and an abnormal longest reflux episode (OR, 8.1 95% CI, 2.8-24.0).